What is the term for a chronic desquamative condition of the lips?
What diseases are associated with cheilitis?
Seb derm, atopic derm, psoriasis, retinoid therapy, pyorrhea, long term actinic damage, lip licking, irritant or allergic contact derm, Plummer-Vinson, Sjogren, AIDS, protease inhibitors
What are some treatments for cheilitis?
Avoid the cause, Protopic, elidel, low strength topical steroids; petroleum or zinc oxide for fissures
What is the most common cause of allergic contact cheilitis?
Lipsticks; over 90% cases occur in women
T/F: Actinic cheilitis involves the lower lip much more frequently than the upper lip.
T/F: Actinic cheilitis often ulcerates.
False; unless carcinoma present
What is the treatment for actinic cheilitis?
Cryosurgery, 5-FU, imiquimod, PDT, CO2 laser, ED/C
What is the diagnosis? Swelling of lower lip with patulous openings of the ducts of glands, with sticky film causing lips to stick together at night.
Cheilitis glandularis: exuberant response to chronic irritation, atopic, factitious, or actinic damage
What is another term for angular cheilitis?
What causes angular cheilitis?
Intertriginous dermatitis, usually caused by excessive wetness or dryness, often in elderly with poor denture fit. Often complicated by infection, eg Candida or Staph aureus.
What measurement is typically abnormal in patients with angular cheilitis?
Shortened vertical dimension of the face, leading to drooling
What are some other less frequent conditions associated with angular cheilitis?
Riboflavin deficiency, anorexia nervosa, Down syndrome, intraoral candidiasis (esp in AIDS, DM, chronic mucocutaneous candidiasis), Sjogren syndrome, drug induced xerostomia, atopic derm
What are some treatments of angular cheilitis?
Dental interventions, toical nystatin and Vioform in hydrocortisone ointment, stronger steroids eg Desonide with anticandidal agent, injection of collagen or implants in the creases, mupirocin ointment if Staph present, surgical grafts
What is the diagnosis? Sharply defined red plaque in the mouth, with shiny glaze. Histologically resembles Zoon balanitis.
Plasma cell cheilitis
What is the diagnosis? Verrucous tumor at angle of mouth with plasma cell infiltrate seen on path.
Plasmoacanthoma. May be associated with candida.
Name some drugs that can cause drug induced ulcers on the lip.
Phenylbutaone, chlorpromazine, Phenobarbital, methyldopa, thiazides; Fixed drug eruption seen with naproxen or oxicams.
What chromosomal disorder is often associated with cheilitis of various types?
What are some of the typical oral findings in Crohn disease?
Swelling or hypertrophy of the mucosa, fissuring/cobblestoning, metallic dysgeusia, gingival bleeding, ulcers, polpoid lesions, fissures on the lower lips, angular cheilitis, granulomatous cheilitis, pyostomatitic vegetans
What % of cases of Crohn disease has oral involvement?
Name some other skin manifestations of Crohn disease.
Pyoderma gangrenosum (although more often UC), EN, PAN, pellagra, pernicious anemia, urticaria, necrotizing vasculitis, metastatic disease with noncaseating granulomas
What steroid is used to treat Crohn disease associated with high first pass metabolism in the liver?
What disease is pyostomatitis vegetans most commonly associated with?
How does pyostomatitis vegetans present?
Edema and erythema with deep folds of the buccal mucosa, pustules, small vegetations, erosions, ulcers, exudates, snail track ulcers with pustules that fuse in to ulcers
What is seen on biopsy of pyostomatitis vegetans?
Dense aggregates of neutrophils and eosinophils
What is the typical course of cheilitis granulomatosa?
Sudden onset of upper lip swelling, then lower lip swelling that progresses and remains permanently
Cheilitis granulomatosa may be the presenting sign of what diseases?
Sarcoidosis or Crohn disease
What is the treatment of Cheilitis granulomatosa?
ILK +/- surgery may work
What is the triad of Melkersson-Rosenthal syndrome?
Recurrent facial paralysis, edema of the lips, scrotal tongue
Where else may you see swelling in Melkersson-Rosenthal?
Dorsal hands/feet and lumbar region, as well as pharynx and respiratory tract
What is the cause of Melkersson-Rosenthal?
What is seen on path with Melkersson-Rosenthal?
Tuberculoid granulomas with lymphedema and perivascular infiltrate
What is the differential for Melkersson-Rosenthal?
Ascher syndrome (swelling of lips and eyelids), angioedema, trauma, infections, lymphangioma, hemangioma, neurofibroma, sarcoidosis
What is the treatment of Melkersson-Rosenthal?
None are good, but can try ILK, surgery, antiobiotics, immunosuppressives
What is the diagnosis? Minute yellowish macules and papules on the oral mucosae.
Fordyce spots, can also see on areolae, glans penis, labia minora
What is Meffert's sign?
Lipstick like mark on the rim of glass with hot beverage in Fordyce spots on the lip
What disease may simulate Fordyce spots?
PXE on the labial mucosa
What are the characteristic findings with stomatitis nicotina?
Red dots with white umbilicated papules, with intervening white or raw red areas, on the palate
What is the diagnosis? Asymptomatic, hard protuberance at midline hard palate.
Torus palatinus, can also occur on floor of mouth
What is scrotal tongue or fissured tongue?
Large tongue with deep grooves along middle
What diseases are associated with fissured tongue?
Melkersson-Rosenthal, Down syndrome, can be seen with geographic tongue in psoriasis patients
What diseases are associated with geographic tongue?
Atopy, psoriasis, AIDS, lithium tx, but most often it is an isolated finding
What are the two clinical variants of geographic tongue?
Discrete annular bald patches of red mucosa with absent filiform papillae vs prominent annular or circinate white raised lines
What is the term for geographic tongue when it occurs with psoriasis or reactive arthritis?
What is seen on biopsy of geographic tongue?
Marked transepidermal neutrophil migration with pustules in the epidermis, and upper dermal mononuclear infiltrate
What is the treatment of geographic tongue?
Usually not needed, but can try tretinoin solution
What causes black hairy tongue?
Hyperplasia of the filiform papillae on the anterior 2/3 of the tongue, with long filaments of orthokeratotic and parakeratotic cells
What are some predisposing factors for hairy tongue?
Excessive smoking, oral antibiotics, candida
What is the treatment of hairy tongue?
Scrub with toothbrush with peroxide, then apply Retin-A gel, 40% urea solution, or papain
What causes smooth tongue?
Atrophy of filiform and eventually fungiform papillae
What is the term for smooth tongue in association with B12 deficiency?
Moeller or Hunter glossitis
What other conditions are associated with smooth tongue?